Health Declaration

Health Declaration For Entering Worksite\Office\Recreational Area etc.

Paper sign-in and health declarations are time consuming, cumbersome, ineffective and difficult to manage.

H2Safety has introduced an online health declaration for you to easily monitor the daily health status of employees or visitors. This effortless system provides you with the information you need while consuming virtually no time, paperwork or app installation. Visitors will scan a QR code at facility entrances or have the URL for this site bookmarked on their phones or computer.

Below you can provide information on the declaration employees or visitors are making. This is an example…

Health Declaration Example

In order to gain access to our work site please confirm the following:

  • I am feeling healthy overall today.
  • I do not currently have any symptoms of COVID-19 (fever, chills, cough, sore throat, muscle aches, severe exhaustion/weakness or shortness of breath).
  • I have not had a fever of 38°C / 100.4°F or greater within the past 72 hours.
  • I agree to respect physical distancing while on site today.

During the previous 14 days I have not:

  • Been advised to self-isolate or quarantine by a doctor or health authority.
  • Traveled outside of the country.
  • Provided direct care for a COVID-19 case*.
  • Lived in the same household as a COVID-19 case.
  • Had direct physical contact with a COVID-19 case (e.g. shaking hands) *.
  • Had direct contact with infectious secretions of a COVID-19 case (e.g. being coughed on, touching used paper tissues with a bare hand) *.
  • Had face-to-face contact with a COVID-19 case within 2 m and > 15 minutes*.
  • Been in a closed environment (e.g. classroom, meeting room, hospital waiting room, etc.) with a COVID-19 case for 15 minutes or more, at a distance of less than 2 m*.
  • Worked in a laboratory handling specimen from a COVID-19 case.
  • Had contact in an aircraft sitting within two seats (in any direction) of a COVID-19 case.
  • Had face-to-face contact (within 2 m and > 15 minutes) with any person who was symptom free but developed COVID-19 within 48 hours of our contact.

I cannot think of any reason I should not be allowed access to the work site today.


Below people will enter their information and submit the form. System administrators are able to access the list and contact information of anyone who made the declaration. They will receive a daily email summary as well as an instant notification for anyone who does not meet the requirements. They can also login at any time to see who attended the site on any given day.

The information entered can be brought into H2Notify to send instant notifications via text & email to anyone who attended the site on any given day.


Please click HERE if you would like to purchase our Health Declaration Service


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